Morphologic and Immunocytochemical Features of High-Grade Serous Carcinoma of Ovary in Ascitic Fluid Effusion and Fine-Needle Aspiration Cytology

Abstract Objectives High-grade serous carcinoma (HGSC) is the most common ovarian malignancy. The role of cytopathology in obtaining tissue diagnosis before institution of neoadjuvant chemotherapy (NACT) was evaluated. Methods All histopathology-proven HGSC specimens between 2015 and 2018 with prior...

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Published in:American journal of clinical pathology 2020-07, Vol.154 (1), p.103-114
Main Authors: Bansal, Akriti, Srinivasan, Radhika, Rohilla, Manish, Sundaram, Archana, Rai, Bhavana, Rajwanshi, Arvind, Suri, Vanita, Saha, Subhash C, Gupta, Nalini, Gupta, Parikshaa, Dey, Pranab
Format: Article
Language:English
Subjects:
Ascites
Ascitic fluid
Biopsy, Needle
Cancer
Cellular biology
Chemotherapy
Cytodiagnosis
Cytology
Cytopathology
Diagnosis
Diagnostic immunohistochemistry
Effusion
Histopathology
Immunocytochemistry
Malignancy
Methods
Oncology, Experimental
Ovarian cancer
Ovaries
p53 Protein
Pathology, Cellular
Pax8 protein
Tumor cells
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Summary:Abstract Objectives High-grade serous carcinoma (HGSC) is the most common ovarian malignancy. The role of cytopathology in obtaining tissue diagnosis before institution of neoadjuvant chemotherapy (NACT) was evaluated. Methods All histopathology-proven HGSC specimens between 2015 and 2018 with prior cytopathologic diagnosis by ascitic fluid evaluation or fine-needle aspiration (FNA) of ovarian mass were reviewed with cell block immunocytochemistry for CK7, CK20, PAX8, WT1, and p53. Results Of 288 cases of HGSC, pre-NACT cytology diagnosis was established in 32% (93/288), with specific HGSC diagnoses made on ascitic fluid in 88% (82/93) and by ovarian mass FNA in 12% (11/93). The ascitic fluid showed moderate/high cellularity with papillary clusters in 76% (71/93) cases. Cell block immunocytochemistry showed tumor cells positive for CK7, PAX8, and WT1. p53 showed mutant or null-type positivity in 65% (33/51) and 33% (17/51) of cases, respectively, with 100% concordance with subsequent histopathology specimens. Poor/intermediate response to chemotherapy was shown in 75% of cases. Conclusions Combined assessment of cytomorphology, cell block histomorphology, and ancillary immunohistochemical testing, including PAX8, WT1, and p53, allows for specific pre-NACT diagnoses of HGSC in ascitic fluid and ovarian FNA cytology. This practice allows for initiation of chemotherapy and diminution of disease burden prior to definitive surgical therapy.
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqaa028